With Health Reform, Waxman Takes On Another Tall Order - washingtonpost.com

With Health Reform, Waxman Takes On Another Tall Order - washingtonpost.com

For his first feat this legislative session, Rep. Henry A. Waxman (D-Calif.) staged a coup and deposed a sitting chairman and dean of the House. He followed that up with a nail-biter victory in the House for his beloved climate change bill.

But on Monday, the hard work will begin for the chairman of the House Energy and Commerce Committee as he labors to advance President Obama's endangered health-reform agenda.

If Obama is to succeed, he will need the 5-foot-5 Los Angeles liberal to quell an uprising by conservative Democrats, overcome a budget gap in excess of $240 billion and possibly swallow compromises on pet issues such as biogenerics and a new government-sponsored health program.



Legislation aimed at overhauling the nation's $2.3 trillion health-care system is so complex that it requires the blessing of three House committees. Last week, two panels approved the bill in little more than a day.

Waxman, though widely considered one of the most tenacious dealmakers in Congress, will have no such luxury. He and his veteran staff are bracing for up to a week of marathon sessions, with the outcome still in doubt. Already, a faction known as the Blue Dog Coalition is saying it has the votes to stop him.

"Henry has the biggest challenge," said House Majority Leader Steny H. Hoyer (D-Md.). In addition to dealing with "some of the most controversial policies" in the sprawling health bill, the committee "has the most diverse representation in the caucus," Hoyer said, which means Waxman must juggle many competing interests within his party.

Elected in 1974 in the class of post-Watergate reformers, Waxman built a reputation as a ferocious investigator, particularly under Republican presidents. After Obama's election, Waxman took on -- and defeated -- Rep. John D. Dingell (D-Mich.) for the top spot on a committee known for its clout.

The hurdles arrayed before Waxman, 69, speak to a more fundamental reality replayed each time Congress attempts to enact universal health care: Dramatically changing an industry that touches every American personally and every business financially is treacherous politics.

"A health-care bill is, under any circumstance, going to be difficult," Waxman said in typical understatement. "If it had been easy, we would have done it a long time ago. But I'm optimistic."

To win passage of a bill that could cost $1.2 trillion over the next decade, House Democratic leaders must hold together an eclectic coalition that includes family farmers, coastal liberals, civil rights heroes and antiabortion Midwesterners.

Many of the tensions arise over government spending. In a response similar to their discomfort over climate change, many of the conservative Democrats threatening to derail health reform say they are worried about the price tag.

"We cannot continue to throw money into a broken system, and I will continue working constructively with the leadership and the administration to address the Blue Dogs' concerns in the days ahead," said Rep. Mike Ross (D-Ark.), chairman of the Blue Dog Health Care Task Force.

The case was bolstered last week by the nonpartisan Congressional Budget Office, which concluded that the bills under consideration do not accomplish Obama's goal of slowing long term the rate of growth in health care.

After 34 years in Congress, Waxman is sensitive to members' "unease about having to answer back home," particularly in swing districts. But he also said he believes that many are falling prey to "misleading" talk on "right-wing radio."

"They are using the rhetoric they used successfully in 1993 and '94," he said, recalling the defeat of President Bill Clinton's health-care bill. "We've learned our lessons."

In a weekend interview, Waxman praised Obama for striking deals with many of the large industries that blocked health reform 16 years ago. But he also made clear that he is not entirely satisfied with the concessions the young president won, particularly from drug companies.

Waxman is girding for two battles involving the pharmaceutical industry. First, he is vowing to recoup the "windfall" the industry made when it stopped paying the government rebates on medicines purchased for people who switched from Medicaid to a new Medicare drug program.

The second and more difficult struggle centers on market protections for companies that produce therapies known as biologics. Derived from living cells instead of the chemical compounds used to make traditional medications, biologics are widely considered the future of the pharmaceutical industry.

But the treatments can be exorbitantly expensive. A one-year course of the breast cancer biologic Herceptin costs about $48,000.

For that reason, consumer groups such as AARP are eager to create an approval path for cheaper generic versions. "These aren't going to benefit people if they can't afford them," said John Rother, AARP's director of public policy.

The industry, backed by Rep. Anna G. Eshoo (D-Calif.), wants 12 to 14 years of market protection called data exclusivity.

"We think that's the right balance between expanding competition without undermining the incentives industry needs to innovate," said Jeff Joseph, a spokesman for the trade group BIO. Investing in biologics is a financially risky business, he said, in which it takes an average of 13 to 16 years to break even.

But the Federal Trade Commission released a report last month saying extra protection was unnecessary because the industry already enjoys the benefits of standard patent protections and the high prices. Waxman proposed granting biologics five years of data exclusivity, while the Obama administration proposed seven years as a "generous compromise."

Lined up with Waxman are many consumer groups, health insurers, pharmacies and major corporations that bear the brunt of soaring medical bills. But Eshoo spokesman Jason Mahler said that with 135 co-sponsors on her bill, Eshoo expects to prevail.

Shortly after Waxman helped push the climate change bill through the House on a 219 to 212 vote, he fainted in his office and was briefly hospitalized.

Still, compared with the eight years he spent keeping tabs on a Republican president, the high-wire legislating is energizing, Waxman said.

"President Obama is not working around the edges. He is taking on big issues, and that leaves many members feeling anxious," he said. "I'm excited by it."